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MEDICAL/HEALTH CARE PROG ANALYST - 68019486

Date: Jan 11, 2018

Location: TALLAHASSEE, FL, US, 32308

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Requisition No: 27766 

Agency: Agency for Health Care Administration

Working Title: MEDICAL/HEALTH CARE PROG ANALYST - 68019486

Position Number: 68019486 

Salary:  $1,574.93 / Bi-Weekly 

Posting Closing Date: 01/25/2018 

This is an open competitive career service position, budgeted for a 40-hour workweek with up to 25% travel.

This is an exciting opportunity within the Agency’s Bureau of Medicaid Program Integrity (MPI).  MPI serves as the primary organizational unit within the Agency for the purposes of prevention, detection, and recoupment/enforcement related to Medicaid program oversight, as well as the lead unit for compliance with contractual and statutory requirements related to fraud and abuse activities.  MPI has several sub-units that serve the overall bureau mission.  Among those sub-units are teams working toward the detection of fraud, abuse, and waste in the Medicaid program (detection units), teams working to strategize the use of bureau resources to maximize fraud prevention efforts (prevention units), teams involved with the oversight and investigation of Medicaid managed care organizations (managed care units), and teams involved with the auditing and recovery of overpayments related to specific Medicaid providers (case management units). 

MPI seeks applicants who are able to demonstrate strong auditing or investigative, research, and organizational skills, as well as have up-to-date knowledge of the Florida Medicaid program. Applicants should also be able to accurately apply software programs needed to complete investigations and audits. The selected candidate needs to demonstrate the ability to utilize data analysis techniques and the ability to conduct investigations, coordinate investigative activities, and accurately document the results of an investigation. Applicants should also possess the ability to review and comprehend applicable federal and state laws, rules, and policies related to health care and enforcement activities. This knowledge will be needed to assist MPI in appropriately conducting investigations, making referrals to other entities, recovering overpayments, applying administrative sanctions, and performing compliance reviews.

This Medical Healthcare Program Analyst position will support the detection and prevention (of fraud and abuse) efforts within the Bureau of Medicaid Program Integrity. The selected candidate may also be responsible for making recommendations for changes to the Medicaid managed care contract related to substantive fraud and abuse language. The unit is seeking a candidate with a broad array of knowledge and experience specifically related to fraud prevention and detection programs, compliance assessment, and the investigative process. Included in the expected assigned functions are activities such as data and programmatic analysis, completion of desk reviews, coordination with other staff, and onsite review activities.

MPI offers a multitude of training opportunities for all MPI employees to enhance their professional growth.  MPI is undergoing some exciting changes and the candidate will be involved in activities of a broader nature within the Agency to support the Agency’s overall mission.

KNOWLEDGE, SKILLS, AND ABILITIES

  • Ability to demonstrate strong investigative, research, and organizational skills.
  • Ability to accurately apply software programs needed to complete investigations.
  • Ability to utilize data analysis techniques.
  • Ability to conduct investigations, coordinate investigative activities, and accurately document the results of an investigation.
  • Ability to review and comprehend applicable federal and state laws, rules, and policies related to health care and enforcement activities.
  • Ability and able to travel with or without accommodations.


MINIMUM QUALIFICATIONS REQUIREMENTS

  • At least two years professional work experience in a position with duties related to prevention, detection, or investigation of fraud, abuse, or waste in health care.
  • Preference will be given to candidates with a program integrity related professional certification, such as: Certified Fraud Examiner; Accredited Healthcare Fraud Investigator; Certified Financial Crimes Investigator; Certified Insurance Fraud Investigator; or Certified Compliance and Ethics Professional.
  • Preference will be given to candidates with a related degree from an accredited college or university, such as: health law, health science, health services administration, business administration, public administration, sociology, criminology, criminal justice, or a substantially similar discipline.
  • A bachelor's degree from an accredited college or university is preferred and three years of investigative, health care, or Medicaid experience.
  • Professional experience can substitute on a year-for-year basis for the preferred college education.

 

CONTACT: SANDY KING (850) 412-4600

The State of Florida is an Equal Opportunity Employer/Affirmative Action Employer, and does not tolerate discrimination or violence in the workplace.

Candidates requiring a reasonable accommodation, as defined by the Americans with Disabilities Act, must notify the agency hiring authority and/or People First Service Center (1-866-663-4735). Notification to the hiring authority must be made in advance to allow sufficient time to provide the accommodation.

The State of Florida supports a Drug-Free workplace. All employees are subject to reasonable suspicion drug testing in accordance with Section 112.0455, F.S., Drug-Free Workplace Act.

VETERANS’ PREFERENCE.  Pursuant to Chapter 295, Florida Statutes, candidates eligible for Veterans’ Preference will receive preference in employment for Career Service vacancies and are encouraged to apply.  Candidates claiming Veterans’ Preference must attach supporting documentation with each submission that includes character of service (for example, DD Form 214 Member Copy #4) along with any other documentation as required by Rule 55A-7, Florida Administrative Code.  Veterans’ Preference documentation requirements are available by clicking here.  All documentation is due by the close of the vacancy announcement. 


Nearest Major Market: Tallahassee